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IV immunoglobulins as add-on treatment to methylprednisolone for acute relapses in MS

From the MS Research Unit (Drs. Sorensen and Ravnborg), Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Neurology (Dr. Haas), Judisches Krankenhaus, Berlin, Germany; Department of Neurology (Dr. Sellebjerg), Glostrup University Hospital, Denmark; and Neuroimmunology Unit (Dr. Olsson), Centre for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.

Address correspondence and reprint requests to Prof. Per Soelberg Sorensen, MS Research Unit, Department of Neurology 2082, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; e-mail: pss{at}rh.dk

Objective: To investigate if IV immunoglobulins (IVIg) in combination with methylprednisolone make recovery from a relapse faster and more complete than methylprednisolone alone. Design/Methods: The authors studied 76 patients with multiple sclerosis (MS) who had an acute relapse with involvement of visual function, upper limb motor function, or gait, and with onset of symptoms between 24 hours and 14 days before. Patients were treated with either IVIg 1 g/kg or placebo (0.1% human albumin), given 24 hours before treatment with IV methylprednisolone 1 g on 3 consecutive days.

Results: Both groups improved, but the authors observed no significant difference between IVIg and placebo patients regarding the primary endpoint, the mean change in the Z-score of the individually chosen targeted neurologic deficit (the most affected system) from baseline to 12 weeks (p = 0.89). A slightly better, but not significant remission was seen in the IVIg group in global scores, i.e., Expanded Disability Status Scale (p = 0.23) and Multiple Sclerosis Impairment Scale (p = 0.24), and in time to next relapse (p = 0.22).

Conclusions: The results do not justify routine application of IV immunoglobulins as add-on therapy to IV methylprednisolone in the treatment of acute multiple sclerosis attacks.

Received April 7, 2004. Accepted in final form July 26, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 14 issue to find the title link for this article.

*Members of the TARIMS Study Group are listed in the Appendix on page 2032.

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Neurology 2004 63: 1992-1993. [Full Text] [PDF]

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